Microvolt T-wave alternans and electrophysiologic testing predict distinct arrhythmia substrates: implications for identifying patients at risk for sudden cardiac death

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Guy AmitOtto Costantini

Abstract

Better risk stratification of patients receiving an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death (SCD) is needed. Although microvolt T-wave alternans (MTWA) and electrophysiologic study (EPS) are independent markers for SCD, the Alternans Before Cardioverter Defibrillator (ABCD) trial found the combination to be more predictive than either test alone. The purpose of this study was to test the hypothesis that EPS and MTWA measure different elements of the arrhythmogenic substrate and, therefore, predict distinct arrhythmia outcomes. The ABCD trial enrolled 566 patients with ischemic cardiomyopathy, left ventricular ejection fraction (LVEF) <or=0.40, and nonsustained ventricular tachycardia. All patients underwent both MTWA test and EPS. The performance of MTWA and EPS in predicting stable ventricular tachyarrhythmic events (S-VTEs) versus unstable ventricular tachyarrhythmic events (U-VTEs), defined as either polymorphic ventricular tachycardia or ventricular fibrillation, was analyzed using Kaplan-Meier event rates and the log rank test. MTWA and EPS were abnormal in 71% and 39% of patients, respectively. There were 28 S-VTEs and 10 U-VTEs. MTWA was predictive of U-VTEs (event rate...Continue Reading

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Citations

Apr 11, 2013·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·S C WijersM Meine
Oct 19, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Raja J SelvarajVijay S Chauhan
May 17, 2011·Cardiac Electrophysiology Clinics·Guy Salama, F G Akar
Apr 27, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Sandeep V Pandit
Oct 20, 2011·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Leonardo CalòErnesto Lioy
Sep 13, 2013·Pacing and Clinical Electrophysiology : PACE·Takeshi KashimuraTohru Minamino
Oct 23, 2012·Journal of the American College of Cardiology·Demosthenes G KatritsisA John Camm
Mar 31, 2015·Physical Review Letters·Enrique Alvarez-LacalleYohannes Shiferaw

Related Concepts

Electrophysiology (Science)
Stroke Volume
Ventricular Fibrillation
Viral Markers
Left Ventricular Function
Sudden Cardiac Arrest
Tachycardia, Ventricular
Benefit-Risk Assessment
His Bundle Electrogram
Kaplan-Meier Estimate

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